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Bipolar Disorder

What is Bipolar Disorder

Previously known as manic depression or manic depressive illness, the terms generally refer to extremes of mood from depression to what is known as being on a “high” or “hypomanic” or “manic” state. These mood symptoms are often associated with impaired ability to work and make decisions, sleep problems, alcohol and drug abuse, sexual promiscuity and bad decision making.

Bipolar disorder affects between 2 and 7 percent of the population directly and many more indirectly – the family, carers, colleagues and friends. Support groups for relatives and carers form an essential part of management of patients with this challenging illness.

The cause of bipolar disorder is unknown but there is strong genetic and familial association between schizophrenia, depression and bipolar disorder.

Symptoms of Bipolar Disorder

The symptoms usually consist of mood extremes which fluctuate with varying frequency and varying severity – sometimes as often as several times a week and sometimes there may only be one episode in a lifetime, and everything in between. Age of first onset of symptoms is typically late teens to early 30s.

There is significant debate in the academic psychiatric community about classification and diagnostic criteria for bipolar disorder and its many subtypes, a task made all the harder by lack of any diagnostic tests.

Manic phase Depressive phase

Diagnosis of Bipolar Disorder

Diagnosis relies on assessment which consists of accurate detailed history taking, including involving the family members and carers, possible investigations for medical conditions which may cause similar symptoms such as thyroid disease, adrenal problems, psychological assessment and possible radiological investigations.

There are no diagnostic tests for bipolar illness and there is considerable debate about just what can be diagnosed as bipolar disorder. For example, some people may wake up feeling “on a high” but this may wane within several hours and by afternoon they may feel “low”.

There may or may not be associated triggers.

Does this constitute bipolar illness?

Or mood instability associated with some personality disorders?

Or “the moodiness” of adolescents?

The jury is out and there is no consensus of opinion.

Types of Bipolar Disorder

There is broad agreement about three main types of bipolar disorder, and these are:

Bipolar I disorder – this is characterized by at least one clearly manic episode and at least one depressive episode, but predominantly recurring manic episodes.

Bipolar II disorder – characterized by at least one “hypomanic” episode (not as severe as full mania) lasting at least four days but predominantly recurring depressive episodes.

Bipolar disorder with mixed symptoms – this is characterized by someone who presents with a mixture of manic and depressive symptoms at the same time.

There are psychiatrists and schools of thought that also include :

rapid cycling bipolar disorder indicating that the cycles of mania-depression occur every within several weeks of each other;

ultra rapid cycling bipolar disorder indicating that cycles occur even more frequently or within days of each other;

Bipolar Disorder in Children

Bipolar disorder in children is highly controversial. There are certainly children who may appear to be moody or grumpy, and this may affect their relationships and school performance. This may have many causes which would be discerned by an assessment by a skilled child psychologist or psychiatrist.

As a matter of principle, medication should be used highly cautiously in children and adolescents as a last resort and only if there are good indications for doing so.

Treatment of Bipolar Disorder

The treatment of bipolar disorder relies on four broad principles:

psychoeducation,

cognitive behavioural therapy,

medication,

involving family in treatment

There is no curative treatment, and all treatment is aimed at preventing recurring episodes of mania or depression and limiting or controlling their severity if such episodes occur.

A combination of individual and group therapy is usually recommended, as well as attendance at day treatment programmes and support groups for families and carers.

In some cases, admission to psychiatric hospital may be necessary.

Psychoeducation CBT Medication Involving family in treatment

Research Update…

Neuroprotection in Bipolar Disorder: A Viable Therapeutic Option

The biological processes involved in causation of bipolar disorder may include inflammatory processes and oxidative stress.

A recent paper published in the Medical Journal of Australia by Prof.Michael Berk of Melbourne University discusses potential novel treatments such as antioxidants, in particular n-acetyl-cysteine, as having impact on clinical course of the illness.